Tag: Becoming a Medicaid Fraud Whistleblower

Before becoming a Medicaid fraud whistleblower, consider the following.

If you notice Medicaid fraud, you may think about becoming a Medicaid fraud whistleblower. You want to do the right thing, and the possibility of a substantial financial reward doesn’t hurt either. But before you blow the whistle, keep the following considerations in mind, because the whistleblowing process isn’t always pretty. Also, it is something that is very hard to stop once it begins.

Retaliation Is Likely

If you decide to be a whistleblower for Medicaid fraud, there’s probably a lot of money at stake. And when that large amount of money stops flowing to the people engaging in the scam, many people will be angry. And on top of that, many people will view you as a traitor, even though you’re doing the right thing. So after blowing the whistle, they will be very upset with you and try to get revenge. This means retaliation is a strong possibility.

The retaliation might be minor or subtle, such as your lunch going missing from the office refrigerator. Or maybe your cubicle mates stop inviting you to drinks after work. But the retaliation can also be very serious, such as a demotion, a drop in pay, physical violence or firing. This is illegal, but it’s often tough to prove. Also, the legal remedies for retaliation aren’t always enough to make it worth being a whistleblower.

A Big Cash Payout Isn’t Easy to Get

In special whistleblower cases, like a qui tam action, you might serve as a “relator.” This is a specific type of legal case. In it, you sue the person or company committing the fraud on behalf of the federal government. And in return for your assistance by becoming a Medicaid fraud whistleblower, you can get about 25 percent of the total amount of money the government is able to recover.

This is an excellent financial reward. It can sometimes be in the tens of millions of dollars, especially in Medicaid qui tam actions. But before you start dreaming about retirement, there are some things to consider. First, you will have to earn that money. Qui tam actions are complex civil lawsuits. You will have to provide a great deal of assistance to the federal government in building a case against the person or company committing the fraud. You should expect to spend a lot of time answering questions and producing documents and other forms of evidence of fraud.

These Cases Take Time

Second, qui tam actions can take a long time to complete. It might be years until it finishes and the federal government recovers some or all of its money. So that’s a long time to litigate a qui tam case and deal with the potential retaliation.

Third, even if you are successful in your qui tam action, the government may not be able to recover as much money as you thought. Perhaps your former boss improperly took $100 million by defrauding Medicaid. But if the federal government recovers only $1 million and your reward is 25 percent, that’s only $250,000 to you. This is a lot less than the $25 million you were hoping to get. Then there’s the fact that it might take three years to get that money and because you were a whistleblower, you lost your job. You need to ask yourself if those three years and a lost job are worth the $250,000.

A Simple Anonymous Phone Call May Not Be Enough

If you want to be a successful whistleblower, you should expect to do more than send off an anonymous email or phone call to the proper authorities. Sometimes this may be enough. An easy investigation quickly uncovers tons of fraud with plenty of evidence to convict and sue everyone involved. But this usually isn’t the case.

It’s very possible that when the federal government receives your email or phone call, they believe you, but that doesn’t mean much unless they can either recover the money or convict those responsible. Both of these possibilities require evidence. To get that evidence, the federal government will need your help. This is for several reasons.

First, the federal government may not have the ability to get the evidence. The Fourth Amendment that prevents the federal government from engaging in searches of private individuals or organizations unless the government can show it has probable cause to make the search and seize evidence. In most cases, an email or phone call from an anonymous whistleblower is not enough to create probable cause.

Second, even if the federal government could investigate the alleged fraud further, it won’t, because it wants to avoid tipping off the people committing the fraud. If the government isn’t careful, the people committing the fraud could destroy evidence or flee to a non-extradition country if they get a whiff of a fraud investigation.